ATTITUDES OF PRIVATE GENERAL-PRACTITIONERS TOWARDS HEALTH-CARE IN SOUTH-AFRICA

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is , however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitione rs (GPs) from a commercial database of 5 000 was conducted to explore attitudes towards health care. A response rate of 67,4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median a ge was 42 years. Most respondents: (i) believed health care to be a ri ght for all citizens; (ii) favoured private or a combination of privat e and public funding mechanisms with fee-for-service arrangements; (ii i) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor o f attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-se rvice remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium univer sities were strongly in favour of a privately funded and fee-for-servi ce orientated system. Those who qualified at black universities, on th e other hand, favoured public funding with less emphasis on fee-for-se rvice. White, English university graduates, while expressing a prefere nce for fee-for-service remuneration, were less enthusiastic about pri vate funding, favouring a mixed funding approach (private and public) instead. This is the first systematic study of GP attitudes to health care in South Africa. Further research is recommended to understand th e significance of the attitudes expressed and to investigate the role of the university medical school and other factors in practitioners' a ttitudes to health care.